title: Impact of a multi-faceted training intervention on the improvement of hand hygiene and gloving practices in four healthcare settings including nursing homes, acute-care geriatric wards and physical rehabilitation units.
abstract: OBJECTIVE
  To assess the impact of a multi-faceted training program on the compliance with hand hygiene and gloving practices.
  
  
  BACKGROUND
  Hand hygiene is considered as the cornerstone of the prevention of hospital-acquired infections. Several studies have enhanced the poor effectiveness of training programs in improving hand hygiene compliance.
  
  
  METHODS
  A before-after evaluation study.
  
  
  METHODS
  The study was conducted in four healthcare settings before and after an intervention program which included the performance feedback of the first evaluation phase, three six-h training sessions, the assessment of hand hygiene performance with teaching boxes and the organisation of one full-day session devoted to institutional communication around hand hygiene in each setting. Hand hygiene compliance and quality of hand rubbing were evaluated. Hand hygiene opportunities were differentiated into extra-series opportunities (before or after a single contact and before the first contact or after the last contact of a series of consecutive contacts) and intra-series opportunities (from the opportunity following the first contact to the opportunity preceding the last in the same series).
  
  
  RESULTS
  Overall, 969 contacts corresponding to 1,470 hand hygiene opportunities (760 during the first phase and 710 during the second) were observed. A significant improvement of observed practices was recorded for the hand hygiene compliance in intra-series opportunities (39·0% vs. 19·0%; p < 10(-5) ), the proportion of gloves worn if indicated (71·4% vs. 52·0%; p < 0·001) and the quality of hand rubbing (85·0% vs. 71·9%; p < 10(-5) ).
  
  
  CONCLUSIONS
  Some of the performances measured for both hand hygiene and gloving practices were improved. We plan to extend this investigation by performing a qualitative study with experts in behavioural sciences to try improving practices for which adherence was still weak after the training program such as hand hygiene in intra-series opportunities.
  
  
  CONCLUSIONS
  This study underscored the usefulness of implementing contextualised training programs, while more traditional courses have shown little impact.
authors.affiliation: UFR Médecine, Université d'Angers & Laboratoire de Bactériologie-hygiène, Centre Hospitalier Universitaire, Angers, France. maeveillard@chu-angers.fr
authors.forename: Matthieu
authors.initials: M
authors.lastname: Eveillard
authors.forename: Françoise
authors.initials: F
authors.lastname: Raymond
authors.forename: Véronique
authors.initials: V
authors.lastname: Guilloteau
authors.forename: Marie-Thérèse
authors.initials: MT
authors.lastname: Pradelle
authors.forename: Marie
authors.initials: M
authors.lastname: Kempf
authors.forename: Marina
authors.initials: M
authors.lastname: Zilli-Dewaele
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Joly-Guillou
authors.forename: Patrick
authors.initials: P
authors.lastname: Brunel
mesh_terms: D017575:Gloves, Protective; D019983:Guideline Adherence; D006235:Hand Disinfection; D058016:Health Facility Administration; D006801:Humans; D006920:Hygiene